Abnormal Psychology Flashcards
What are the essential features of the intellectual disability (intellectual developmental disorder)?
- general mental abilities(deficits in their ability to think)
- impairment in everyday adaptive functioning (ability to adapt to the normal demands of normal life)
What are the three areas of adaptive functioning?
Intellectual Developmental Disorder
- Conceptual(academic): depends on language, math, reading, writing, reasoning, and memory to solve problems, judgment in novel situations
- Social: awareness of other’s thoughts, feelings, and experiences; empathy, interpersonal communication, social judgement, and friendship abilities, self-regulation
- Practical: regulating behavior, organizing tasks, money management, personal care, job responsibilities, and recreation.
The patient’s success on adaptations depends on patient’s education, job training, motivation, personality, support from significant others, and intelligence level.
What qualifies an Intellectual Developmental Disorder (IDD) and what are the different levels of severity?
Mild(50-70)85%of all patients with IDD, Moderate(high 30s to low 50s) represent 10% of all patients with IDD, Severe (low 20s to high 30s) roughly make up 5% of all IDD patients, Profound (low 20s downward)
IQ needs to be two standard deviations from the norm, Plus at least one domain of adaptive functioning
What is the Borderline Intellectual Functioning IQ range?
71-84, persons who do not have the coping problems associated with intellectual disability
What is the age of onset of Intellectual Developmental Disability?
What are behavioral problems commonly associated with Intellectual Developmental Disability?
Age of onset typically during childhood and adolescence-even before birth.
If behavior begins at age 18 or after, it is called a MAJOR NEUROCOGNITIVE DISORDER (Dementia)-Dementia &Intellectual Developmental Disability can coexist.
Behavioral problems: aggression, dependency, impulsivity, passivity, self-injury, stubbornness, low self-esteem, and poor frustration tolerance. Gullibility and naivete can lead to risk for exploitation by others.
Describe some of the etiologies of Intellectual Developmental Disabilities.
- Genetic causes (about5%) Chromosomal abnormalities, Tay-Sachs, tuberous sclerosis
- Early pregnancy factors (about 30%). Trisomy 21(Down syndrome), maternal substance use, infections
- Later pregnancy and perinatal factors(about 10%) Prematurity, anoxia, birth trauma, fetal malnutrition
- Acquired childhood physical conditions (about5%) Lead poisoning, infections, trauma
- Environmental influences and mental disorders(about 20%) Cultural deprivation, early-onset schizophrenia
- No identifiable cause (about 30%)
Describe Differential Diagnosis for Intellectual Developmental Disorder.
- Cognitive Disorders (e.g., Down’s syndrome that gets a head injury and declines cognitive functioning, or develops Alzheimer’s disease- can have both diagnosis IDD and neurocognitive disorder dx)
- Communication Disorders and Specific Learning Disorders
- Autism Spectrum Disorder
By Law the term Developmental Disability is used and applied to anyone who by age of…
22 has permanent problems functioning in at least three areas because of mental or physical impairment.
Global Developmental Delay is Diagnosed for patients under the age of…
age 5, who have not been adequately evaluated.Such child may have delayed developmental milestones
Autism Spectrum Disorder requires deficits in both areas by level of severity(level 1mild, level2moderate, and level3severe)
Assess these two areas separately:
1. Communication and Socialization: COMMUNICATION:speak clearly or others have unusual speech patterns and idiosyncratic use of phrases. May speak too loudly or lack prosody(lilt) that supports the music of normal speech.Fail to use body language or other nonverbal behavior to communicate. may not understand basis of humor, may have problems understanding abstract meaning, trouble beginning or sustaining conversation, may talk to selves or hold monologues on subjects that interest them but not to other people. May ask questions over and over even after obtained repeated answer.
SOCIALIZATION: slower maturation than normal children; parents in the second 6 months concerned when child not make eye contact, smile reciprocally, or cuddle, instead arch away from parent’s embrace and stare in space. Toddlers don’t point to objects or play with other children. They may not stretch their arms to be picked up or show normal anxiety at separation from parents. As a result of frustration of inability to communicate, results in tantrums and aggression in young children. little requirement for closeness, older children have few friends and seem not to share toys or sorrows with other people. In adolescence and beyond, absent need for sex.
2. Motor Behavior(Restricted, repetitive patterns of behavior, interests, or activities-RRBs): Motor milestones usually arrive on time. Compulsive or ritualistic actions (called stereotypies)-twirling, rocking, hand flapping, head banging, and maintaining odd body postures that mark them as different. Suck on toys or spin them rather then use them as symbols for imaginative play. Their restrictive insterests lead them to adhere to rigidly to routine. Appear indifferent to pain or extremes of temperature; preoccupied with smelling or touching things. Injure selves by head banging, skin picking, or repetitive motions.
How many patients with Autism Spectrum Disorder have sensory abnormalities?
90%; some children hate bright lights, loud sounds, even prickly texture of certain fabrics or other surfaces. A small minority have “splinter” skills–special abilities in computation, music, or rote memory that occasionally rise to the level of savantism.
What are physical conditions associated with Autism Spectrum Disorder?
phenylketonuria, fragile X syndrome, tuberous sclerosis, and a history of perinatal distress.
Comorbidity with other mental disorders and Autism Spectrum Disorder?
Anxiety(especially prevalent), depression(2-30%), OCD (1/3), ADHD(1/2), Intellectual disability(1/2), and seizures(25-50%)
Some patients complain of initial insomnia or reduced need for sleep; a few even sleep days and remain awake nights. Researchers have recently reported association of a form of autism with a gene responsible for kidney, breast, colon, brain, and skin cancer.
What is Autism Spectrum Disorder prevalence?
Incorporating the former diagnoses of autistic, Rett’s, Asperger’s and childhood disintegrative disorders, Austistic Disorder’s overall prevalence is about 6 per 1,000 children in the general population. Affects all cultural and socioeconomic groups. BOYS twice or up to four times as often affected as girls. Siblings of patients with Autism Spectrum Disorder have a greater elevated risk for the same disorder.
Describe different levels for Autism Spectrum Disorder
Social Communication
Level1 (Mild): The patient has trouble starting conversations or may seem less interested than most people in social interactions.Code as “Requiring Support”
Level2(Moderate): There are marked deficits in both verbal and nonverbal communication. Code as “Requiring substantial support.”
Level3(Severe): Little response to the approach of others markedly limits functioning.Speech is limited, perhaps to just a few words. Code as “Requiring very substantial support.”
Restricted, repetitive behaviors
Level1(Mild): Inflexibility of behavior causes significant interference with functioning in one or more contexts. Change provokes some problems in at least one area of activity. Code as “Requiring Support.”
Level2(Moderate): Problems in coping with change are readily apparent and interfere with functioning in various areas of activity. Code as “Requiring substantial support.”
Level3(Severe): Change is exceptionally hard; all areas of activity are influenced by behavioral rigidity. Causes severe distress. Code as “Requiring very substantial support.”
What are the Differential Diagnoses for Autism Spectrum Disorder?
normal children may have strong preferences and enjoy repetition; consider intellectual disability, stereotypic movement disorder, obsessive-compuslive disorder(OCD), social anxiety disorder, language disorder,
-Rett’s syndrome, ADHD, Selective Mutism, Schizophrenia
Describe Attention-Deficit/Hyperactivity Disorder criteria
- Inattention: difficulty paying attention, maintaining focus on their work or play, distracted, neglect details, and make careless mistakes, poor organization skills, lost assignments, inability to follow through with chores or appointments
- Hyperactivity/Impulsivity: forever in motion, fidgets, disruptive in class, restless, jumps out of seat, talking endless, interrupting others, seeming unable to take turns or to play quietly, runs, or climbs.
Duration 6+ months; Onset before age 12(raised from 7 years) For Adults or adolescents age 17 years need 5 symptoms from criteria A1. Inattention. Disability-work/educational, social or personal impairment
What are differential Diagnoses for Attention-Deficit/Hyperactivity Disorder?
intellectual disability, anxiety, and mood disorders, autism spectrum disorder, conduct disorder, oppositional defiant disorder, intermittent explosive disorder, specific learning disorders, disruptive mood dysregulation disorder, psychotic disorders, or other mental or personality disorders
Prevalence for Attention-Deficit/Hyperactivity Disorder
Males 2:1 than females in general population, with a ratio of 2:1 in children and 1.6:1 in adults; Females more likely to present primarily with inattentive features;
Runs in families-Parents and siblings more likely than average to be affected. Alcoholism and divorce as well as other causes of family disruption common in family backgrounds with ADHD.
Other Disorders associated with Attention-Deficit/Hyperactivity Disorder?
Also, genetic association with antisocial personality disorder and somatic symptom disorder. Also ADHD are learning disorders, problems reading. In adults, look for substance use, mood, and anxiety disorders.
Other disorders-co-occur with ADHD-Oppositional defiant disorder and conduct disorder, each in a substantial minority of patients with ADHD. Disruptive mood dysregulation disorder may be even more strongly associated. Specific learning disorders, OCD, tic disorders. Adults may have antisocial personality disorder and substance use problem.
When would Other or Unspecified Attention-Deficit/Hyperactivity Disorder be used?
with patients with prominent symptoms that do not fulfill the criteria for ADHD proper. Examples would include people whose symptoms begin after the age 12 or whose symptoms are too few. Impairment is key to qualify. If want to specify the reason why ADHD doesn’t work for the patient, choose F90.8[314.01]Other ADHD and tack on something like “symptoms first identified at age 13.” otherwise choose unspecified.
Essential features for Tic Disorders (compared)
Touretts’s Persistent(chronic)motor/ Provisional
disorder or vocal tic disorder tic disorder
type
1+vocal tic& motor or vocal motor or vocal tics
2+motor tics tics, but NOT both or both, in any
(beginby18,typically age 4-6) quantity
Duration
Longer than 1 year longer 1year less than 1yr
ALL must begin by age 18
—————————– Motor tics only or—————————
specify if vocal tics only
Tic definition
ALL Abrupt, nonrhythmic, quick , repeated
Differential Diagnoses for Tourette’s Disorder
OCD, other Tic Disorders, substance use, and physical disorders
-In Tourette’s Disorder, motor and vocal tics need not occur in the same time frame
The best tic of all–caprolalia-swear words and other socially unacceptable speech-is relatively uncommon.
Essential Features of Language Disorder and Describe Differential Diagnoses
Beginning in childhood, a patient’s use of spoken and written language consistently lags behind age expectations. Compared to age-mates, patients will have small vocabularies, impaired use of words to form sentences and reduced ability to employ sentences to express ideas.
Differential Diagnoses: sensory impairment, autism spectrum disorder, intellectual disability, learning disorder-though these can coexist with Language Disorder
Essential Features of Speech Sound Disorder(aka phonological disorder)
AND Describe Differential Diagnoses
Problems producing the sounds of speech, compromising communication. EX: lisping, “gaspetti” for spaghetti, not errors found in those who learn English as a second language.
Condition is familial and can occur with other language disorders, anxiety disorders, including selective mustism, and ADHD.
Differential Dx: physical disorders such as cleft palate or neurological disorders; sensory impairment such as hearing impairment; selective mutism
Essential Features of Childhood-Onset Fluency Disorder(aka stuttering) and Differential Dx
Stutterring is reported by people to cause anxiety or frustration, even physical tension. Children are observed clenching their fists or blinking their eyes in effort to regain control when there is extra pressure to succeed (as when speaking to a group). Stuttering occurs especially with consonants; the initial sounds of words, the first word of a sentence, and words that are accented, long, or seldom used. It may be provoked by a joke telling, saying one’s name, talking to strangers, or speaking to authority figures. Stutterers often find that they are fluent when singing, swearing, or speaking to the rhythm of a metronome.
-On average stuttering starts at age 5 but can begin as young as 2. Sudden onset may correlate with greater severity. As many as 3% of young children stutter; % higher for children with brain injuries or intellectual disability. Boys outnumber girls at least 3:1. Adults 1:1000, of whom 80% male. Runs in families. Genetic component and links to Tourette’s disorder, which is a dopamine related disorder; dopamine antagonists have been used to ameliorate the effects of stuttering.
Differential Dx: Speech motor deficits; neurological conditions such as stroke; other mental disorders
Essential Features of Social(Pragmatic) Communication Disorder and describe Differential Dx
Despite adequate vocabulary and ability to form sentences, persons still have problems with the practical use of verbal and nonverbal language.This is called pragmatics:
using language for social reasons, adapting communication to fit the context, following the conversations (rules) of conversation, and understanding implied communications.
usually identified by age 4-5
*If patient has difficulty understanding and using pragmatic aspects of social communication to the point that their conversations can be socially inappropriate. Yet, they do not have the restricted interests and repetitive behaviors that would qualify them for a diagnosis of autism spectrum disorder.
Differential dx: physical or neurological conditions, autism spectrum disorder, intellectual disability, learning disorders, social anxiety disorder, ADHD
Essential Features of Specific Learning Disorder
Impairment in:
1. Reading(Dyslexia): several forms…difficulty with comprehension or speed when the person is reading silently; with accuracy when the person is reading aloud; when person trying to spell. Normally distributed throughout population and occurring at every intelligence level, dyslexia affects about 4% of school-age children, most of them boys.Dyslexia attributed to environmental factors(lead poisoning, fetal alcohol syndrome, low ses) and familial causes (inheritance may account for 30% of cases).Clinicians rule out vision and hearing problems, behavioral disorders, and ADHD(which is often comorbid).
Early identification: Reading at two standard deviations below population mean signifies an especially poor outlook. when treated at age 7 could read normally by age 14. parent’s edu level and child’s overall intellectual capabilities need to be considered.
2. Mathematics(Dyscalculia): Persons have difficulty performing mathematical operations(number sense, memorization of arithmetic facts, accurate or fluent calculations, or accurate math reasoning)–as simple addition or as complex as story problems–not know the cause.It could be part of a larger nonverbal learning disability or a problem in making a connection between number sense and the representation of numbers.5% school age are affected. Gerstmann’s syndrome is acollection of sxs that results from a stroke or other damage to the left parietal lobe of the brain in the region of the angular gyrus.
3. Written Expression: problems with grammar, punctuation, spelling, and developing their ideas in writing. Children have problems translating ideas from oral/auditory form to visual/written form; what they write may be too simple, too brief, or too hard to follow. Some have trouble generating new ideas. Handwriting may be indecipherable, yet you wouldn’t make diagnosis when poor penmanship is the only problem.Problem usually doesn’t appear until 2nd grade or later–after onset of reading learning disorder. Writing demands increase from third to sixth grade. It can be due to troubles with working memory(there’s a problem with the organization of what the child is trying to say). The dx is generally not appropriate if px is poorly coordinated, as in developmental coordination disorder.
-For each specify Severity:mild(some problems, but often with support the patient can compensate well enough to succeed), moderate(marked difficulties, these will require considerable remediation for proficiency. some accommodation may be needed),& severe(critical problems will be difficult to overcome without intensive remediation. Even extensive supportive services may not promote adequate compensation)
**School records of impairment can be used instead of testing for someone 17+ years
Describe Differential Dx for Specific Learning Disorder
physical disorders such as vision, hearing or motor performance; intellectual disability; ADHD
What is a delusion?
A Delusion is a false belief that cannot be explained by the patient’s culture or education; the patient cannot be persuaded that the belief is incorrect, despite evidence to the contrary or the weight of opinion of other people. Many types of delusions(erotomanic-in love w/px of higher status; grandeur-px is God or movie star; guilt-px committed an unpardonable sin or grave error; jealousy-spouse or partner unfaithful; persecution-px being followed, interfered with;poverty-px faces destitution; reference-px being talked about in press or tv; somatic-px body functions altered-they smell bad or have terrible disease; thought control-other’s putting ideas into px’s minds.
Delusions must be distinguished from Overvalued ideas, which are beliefs that are not clearly false but continue to be held despite lack of proof that they are correct.EX:belief in superiority of one’s race or political party.
What is a hallucination?
A hallucination is a false sensory perception that occurs in the absence of a related sensory stimulus. Hallucinations are nearly always abnormal and can affect any of the five senses, though auditory and visual hallucinations most common. But they don’t always mean that the person experiencing them is psychotic.
To count as psychotic sxs, hallucinations must occur when a person is awake and fully alert. Ex: during delirium does not count or when someone is experiencing falling asleep(hypnagogic) or awakening(hypnopompic). These experiences are normal and not true hallucinations, they are referred as imagery.
Another requirement for a psychotic sx is that a person must lack insight into its unreality.EX: Charles Bonnet syndrome, in which people who have significant loss of vision see complex visual imagery-but with full realization that the experience is unreal.
Hallucinations must be discriminated from ILLUSIONS, which are simply misinterpretations of actual sensory stimuli. They usually occur during conditions of decreased sensory input, such as at night. EX:impression in dark pile of clothes is burglar when turn on lights it’s pile of clothes.Illusions are common and normal.
What is disorganized speech?
Disorganized speech(loose associations) mental associations are governed not by logic but by rhymes, puns, and other rules not apparent to the observer, or by evident rule at all. Speech must be so badly impaired that it interferes with communication.
What is disorganized behavior?
Disorganized behavior or physical actions that do not appear to be goal-directed disrobing in public, repeatedly making the sign of the cross, assuming and maintaining peculiar and often uncomfortable postures–may indicate psychosis.
What are negative symptoms?
Negative sxs include reduced range of expression of emotion (flat or blunted affect), markedly reduced amount or fluency of speech, and loss of the will to do things(avolition). Negative sxs give the impression that something has been taken away from the px. Negative sxs reduce the apparent textural richness of a patient’s personality. However, they can be hard to differentiate from the dullness due to depression, drug use, or ordinary lack of interest.
What are the 5 symptoms that are needed to determine psychotic disorder?
- Delusions
- Disorganized speech
- Disorganized Behavior
- Negative Symptoms
- Hallucinations
What are the four things to consider when diagnosing DSM-5 various types of psychosis?
- type of psychotic symptom(delusions, disorganized speech and behavior, negative symptoms, hallucinations)
- course of illness (duration-at least 6 months for schizophrenia; precipitating factors-severe emotional stress-brief period of psychosis vs. stress of childbirth postpartum psychosis; previous course of illness-hx of complete recovery from psychosis suggests a disorder other than schizophrenia; premorbid personality-good social and job related functioning before the onset of psychosis directs diagnostic focus away from schizophrenia and toward another psychotic disorder such as depression or psychosis due to another medical condition or substance use; residual symptoms-once acute psychotic sxs treated, residual sxs may persist.often milder manifestations of person’s earlier delusions or active psychotic sxs:odd beliefs, vague speech that wanders off the point. Return of psychosis.
- consequences of illness-affect functioning of px and family. Px w/schizophrenia must have materially impaired social or occupational functioning.Other dx not require this criterion for dx.Ex: Delusional disorder specifies that functioning is not impaired in any way except that it relates to delusions.
- exclusions-once fact of psychosis established, differential dx of physical conditions ruled out. History, physical examination and lab testing.Then substance-related disorders ruled out.History of px using cocaine, alcohol, psychostimulants, and psychotomimetics, that can cause psychotic sxs that closely mimic schizophrenia. The use of prescription medications(such as adrenocorticosteroids) can also produce sxs pf psychosis. Finally, consider mood disorders-mania or depression? History of mental health treatment as some pxs with mood disorders have been diagnosed as schizphrenia.
5.Other Features: Family History of illness-A close relative w/schizophrenia increases your px chances of also having schizophrenia.Bipolar I also runs in families.More fam. Hx
Response to medication-Regardless of how psychotic the px appears, previous recovery with, a medication, ex:lithium, tx suggestes a dx of mood disorder.
Age at onset-Schizophrenia usually begins by a person’s mid-20’s. Onset of illness after the age of 40 suggests some other dx. It could be delusional disorder but should consider a mood disorder. Late onset does not rule out schizophrenia.
Essential features of Schizophrenia and differential diagnosis
- 3-6years before becoming ill(prodromal period)-characterized by abnormalities of thought, language, perception, and motor behavior
- At least 6 months behavior changes-delusions and hallucinations may start or disorganized speech/behavior(catatonia)–at least two of the symptoms for at least a month and illness causes problems in work and social functioning.
- Clinician excludes other medical disorders, substance use, and mood disorders as probable causes.
- Check sxs for frequency, chronicity, severity, management in terms of cognitive dysfunction, dysphoria(anger, anxiety, depression), absence of insight of illness, sleep disturbance, substance use, suicide.
Differential Dx: other psychotic disorders, mood, cognitive disorders, physical and substance induced psychotic disorders, or peculiar ideas –political or religious–shared by a community
**Can use Severity dimensional continuum and rate each level from 0 to 5. optional
Schizophrenia and Schizophrenia-Like Disorders Summary List
- Schizophrenia. For at least 6 months, these pxs have had 2 or more of the 5 types of psychotic sxs:delusions, disorganized speech, hallucinations, negative sxs, and disorganized behavior (catatonia). One of which has to be either delusion, hallucination, or disorganized speech. Ruled out as causes of the psychotic sxs are significant mood disorders are significant mood disorders, substance use, and general medical conditions.
- Catatonia associated with another mental disorder(catatonia specifier). These pxs have 2 or more of several behavioral characteristics (stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, and echopraxia). The specifier can be applied to disorders that include psychosis, mood disorders, autistic spectrum disorder, and other medical conditions.
- Schizophreniform disorder. This category is for pxs who have the basic sxs of schizphrenia but have been ill for only 1-6months–less than the time specified for schizophrenia.
- Schizoaffective disorder. For at least 1 month, these patients have had basic schizophrenia sxs; at the same time, they have prominent symptoms of mania or depression.
- Brief psychotic disorder. These pxs will have had at least one of the basic psychotic sxs for less than 1 month.
Essential features of Schizophreniform Disorder and Differential Dx
Relatively rapid onset and offset. Young person (late teens or 20s) who for 30 days to 6 months has (1) delusions(especially persecutory) and (2) hallucinations (especially auditory). However, some pxs will have (3) speech that is incoherent or otherwise disorganized, (4) severely abnormal psychomotor behavior(catatonic symptoms, or (5) negative symptoms such as restricted affect or lack of volition (lack motivation to do work or family life). Diagnosis requires at least 2 of these 5 types of psychotic symptoms, at least one of which must be delusions, hallucinations, or disorganized speech. The patient recovers fully within 6 months.
Differential Dx: physical and substance-induced psychotic disorders, schizophrenia, mood disorders, or cognitive disorders.
Specify: With or Without good prognostic features.
*If it’s still within 6 months and px is still ill use specifier (provisional). Once the px has fully recovered then remove the specifier. If still ill after 6 months, then change dx to schizophrenia or some other disorder. May specify severity but not have to.
Essential features of Brief Psychotic Disorder and Differential Dx
All within a course of a single month, the px develops, then recovers completely from an episode of psychosis that includes delusions, hallucinations, or disorganized speech(disorganized behavior may also be present). The episode lasts at least 1 day but less than 1 month.
Differential dx: mood or cognitive disorders, psychoses caused by medical conditions or substance use, schizophrenia
*If you make the diagnosis without waiting for recovery, you’ll have to append the term (provisional)
*Can specify: With postpartum onset.Sxs begin within 4 weeks of giving birth.
With or Without marked stressors. Stressors must appear to cause the sxs, must occur shortly before their onset, and must be severe enough that nearly anyone of that culture would feel markedly stressed.
Can specify severity not have to.
prevalence two fold in females than males
may appear in adolescence and early adulthood and onset can occur across the lifespan, average age onset mid 30s. Preexisting personality disorders and traits (schizotypal, borderline personality disorder or traits in the psychoticism domain perceptual dysregulation and negative affectivity domain such as suspiciousness) may predispose the individual to the development of the disorder.
Essential features of Delusional Disorder and Differential Dx
For at least a month, the px has had delusions but no other psychotic symptoms and any mood symptoms are relatively brief. Other than the consequences of the delusions, behavior isn’t much affected(not bizzare or odd).Can be believeable and not have to be bizarre.
There might be some hallucinations of touch or smell BUT only as they relate to the delusions. And they won’t be prominent.
Duration is 1month or longer. Distress and diability-None, except as related to the delusional content.
Differential dx: physical and substance-induced psychotic disorders(ex:amphetamine-induced psychotic disorder with onset during withdrawal), mood (assess chronology and severity of mood sxs if any develop either before or after delusion sxs-if secondary to delusions-Need info from third parties like relatives to determine which came first.Mood sxs must be relatively mild and brief to sustain a dx of delusional disorder) or cognitive disorders(ex:dementia w/delusions), schizophrenia, obsessive-compulsive disorder
Can specify type of delusion: erotomanic, grandiose, jealous, persecutory, somatic, mixed, or unspecified.
Specify if: With bizarre content.this denotes obviously improbable delusions(ex:stranger removed internal organs and replaced with someone else’s organs without leaving scars)
If delusion disorder lasted at least a year, specify course:
first episode, currently in acute episode
First episode, currently in partial remission
First episode, currently in full remission
Multiple episodes, currently in acute episode
‘‘…partial remission
‘‘…full remission
Continuous
Unspecified
Essential features of Schizoaffective Disorder and Differential Daignosis
The mood sxs (Manic episode or Major depressive episode) are important in that they must be present during half of more of the total duration of the illness. **The psychosis sxs(delusions and hallucinations) are important in that they must be present by THEMSELVES for at least 2 weeks.(Note criteria is silent on whether to count psychosis sxs that are present during the time that mood sxs have disappeared under tx). During this same continuos period, the px fulfills the criterion A requirement for schizophrenia without having a mood episode.
Duration-a total of 1+months
Differential Dx: psychotic mood disorders, substance use, and physical disorders
Specify: Bipolar Type
Depressive type
If lasted at least 1 year, specify course:
First episode in acute episode….
Multiple…
Continuous
Unspecified
-Higher incidence in females than males
Higher risk in first degree relatives who have schizophrenia, bipolar, or schizoaffective disorder
Overdiagnoses of African Americans and Hispanics w/schizoaffective disorder
Schizoaffective disorder is associated with social and occupational dysfunction but dysfunction is not a diagnostic criterion as it is for schizophrenia.
Essential Features of Substance/Medication -Induced psychotic Disorder and Differential Dx
The use of some substances appears to have caused hallucinations or delusions (or both).
Only make this dx when sxs are serious enough to justify clinical attention & they are worse than you’d expect from ordinary intoxication or withdrawal.
Consider:
1. Sxs begin soon after(or during)the use of substance or its withdrawal.
2.They start after a px has begun use of a medication.
3.The drug/medication is known to be capable of causing the sxs in question.
4. Of course if your px has had a prior episode of the same sxs that did follow the use of the same substance, that’s perhaps the best evidence of all.
Distress or Disability-work/academic, social,occupation;
Differential Dx: schizophrenia spectrum disorders, delusional disorder, ordinary substance intoxication or withdrawal, delirium
Classes/names of Medications that can cause Mental Disorders
Analgesics: anxiety, mood, psychosis, delirium
Anesthetics:anx, mood, psychosis, delirium
Antianxiety agents: mood
anticholinergics:anxiety, mood, psychosis
anticonvulsants:anxiety, mood, psychosis, delirium
antidepressants:anx, mood, psychosis, delirium
antihistamines:anx, psychosis, delirium
antihypertensives/cardiovascular drugs: anx, mood, psychosis, delirium
antimicrobials:mood, psychosis, delirium
antiparkinsonian agents:anx, mood, psychosis, delirium
antipsychotics:anx, mood, delirium
antiulcer agents: mood
bronchodialators:anx, delirium
chemotherapeutic agents:psychosis
corticosteroids:anx, mood, psychosis, delirium
disulfiram(Antabuse):mood, psychosis
Gastrointestinal agents:psychoses, delirium
Histamine agonist:delirium
Immunosuppressants:delirium
Insulin:Anxiety
Interferon:anx,mood, psychosis
Lithium:anxiety
Muscle relaxants:mood, psychosis, delirium
NSAIDs:psychosis
Oral contraceptives:anxiety, mood
thyroid replacements:anxiety
Essential features of Catatonia associated with another mental disorder (catatonia specifier)
The clinical picture os dominated by 3 or more of the following sxs:
- Stupor (no psychomotor activity;not actively relating to environment)
- Catalepsy(passive induction of a posture held against gravity)
- waxy flexibility(slight even resistance to positioning by examiner)
- Mustism(no or very little verbal response[exclude if known aphasia]
- Negativism(opposition or no response to instructions or external stimuli)
- Posturing(sponteneous and active maintenance of a posture against gravity)
- Mannerism(odd,circumstantial caricature of normal actions
- Stereotypy(repetitive, abnormally frequent,non-goal-directed movements
- Agitation,not influenced by external stimuli
- Grimacing
- Echolalia(mimicking another’s speech)
- Echopraxia(mimicking another’s movements)
The px has prominent sxs of catatonia and can apply specifier to manic, hypomanic, or major depressive episodes, schizophrenia, schizophreniform, schizoaffective, brief psychotic and substance-induced psychotic disorders. It can even be used for autism spectrum disorder.
Essential features of Catatonia associated with another medical condition (catatonia specifier)
A list of some medical conditions that can produce catatonic behavior includes: liver disease, strokes, epilepsy, uncommon disorders such as Wilson’s disease (a defect of copper metabolism) and the inherited disease (autosomal dominant), tuberous sclerosis.Neurological and medical consultation is needed for labs and X-ray studies.Urine and blood screens for toxic substances or drugs of abuse need to be considered as well as MRI.
A physical illness appears to have caused sxs of catatonia.
Differential Dx: delirium or other cognitive disorder, schizophrenia spectrum disorders, psychotic mood disorder, OCD.
Coding: Use name of the medical condition, record dx after you’ve coded the actual medical condtition
EX: D32.9[225.2] Cerebral meningioma, benign
F06.1 [296.89] Catatonic disorder due to cerebral meningioma
What are the 5 major requirements of a major depressive episode?
- Quality of depressed mood(or loss of interest or pleasure)-mood lower than normal, “unhappy,” or expressing sadness BUT some pxs experience changes in functioning, loss of pleasure in activities
- that has existed for a minimum period of time-for at least 2 weeks
- is accompanied by a required number of symptoms-depressed mood, loss of pleasure, loss of weight or appetite, sleep, fatigue, psychomotor retardation(speech or phyisical movements slowed, marked pause before answering a question or initiating an action), agitated, low-self-esteem, guilt, death wishes, suicidal ideas. These behaviors have to occur nearly everyday.
- had resulted in distress or disability-impair work or school performance, social life(withdrawal or discord) or some other area of functioning, including sex.
- violates none of the listed exclusions-regardless of teh severity or duration of sxs, Major depressive episode usually should not be diagnosed in the face of clinically important substance use or a general medical disorder that could cause the sxs
Differential dx:substance use or physical disorders
Children and adolescents may only feel or seem irritable not depressed
20% adult women
10%adult men experience major depressive episode
What is a manic episode?
The classic triad of manic sxs consists of heightened self-esteem, increased motor activity, and pressured speech.
occurs in 1% of all adults.
Quality of mood-some pxs w/mild sxs enjoy good humor and laugh but when mania worsens becomes less cheerful and takes on a “driven” unfunny quality that is irritable; euphoria and irritability sometimes occur together.
Must have sxs for a minimum of 1 week.This requirement helps to differentiate manic episode from hypomanic episode.
Sxs-heightened self-esteem can become grandiose and delusional that delusions are keeping with euphoric mood and are called mood-congruent.Rested on little sleep, heightened activity which may be goal-directed and useful, lost judgment, rapid and pressured speech, flight of ideas, easily distracted
Impairment-Typically problems with co-workers and strained relationships with friends, mania helps at first with increased energy increased productivity at work and school but as mania worsens px less able to focus. Sexual entanglements result in divorce, unwanted pregnancy. After episode resolved, guilt remain.
Exclusions-General medical conditions such as hyperthyroidism can produce hyperactive behavior; pxs who misuse certain psychoactive substances (especially amphetamines) will appear speeded up and may report feeling strong, powerful, and euphoric.
Differential Dx:Substance use and physical disorders, schizoaffective disorder, neurocognitive disorders, hypomanic episodes, cyclothymia)
Can have the specifier WIth Mixed Features-“Microdepressions”Acute manic episode with brief episodes of depression.
-Informants can clarify history if the substance use or mania came first.
Informants can also give history about Catatonic sxs occurring during a manic episode and sometimes causing the episode to resemble schizophrenia…but a hx of acute onset and previous episodes with recovery can help clarify dx. Then the specifier with catatonic features may be indicated.
Mania is a building block of bipolar I disorder
What is a hypomanic episode?
Same Sxs as manic episode, especially those who have bipolar II.
Quality of mood tends to be euphoric without the driven quality present in manic episode, though mood can instead be irritable. It is clearly different from the patient’s usual nondepressed mood.
Duration for a minimum of 4 days–a marginally shorter time requirement than that for manic episode.
Sxs-change in mood(euphoria or irritability), px must have an increase in energy or activity level for at least 4 days.Then 3 sxs from list for at least 4 days. If px abnormal mood is irritable and not elevated, 4 sxs are required. Sleep may be brief and activity level may be increased sometimes to the point of agitation. Judgment deteriorates and may lead to consequences in work or finances or social life. Speech may be rapid and pressured; racing thoughts or flight of ideas may be noticeable; Easily becoming distracted can be a feature of hypomanic episode. Heightened self-esteem is never grandiose that it becomes delusional, and hypomanic pxs are never psychotic.
Impairment-Lapses of judgment such as spending sprees and sexual indiscretions can occur in both manic and hypomanic episodes but by definition only a px who is truly manic will be seriously impaired.
Rule out substance/medication-induced sxs, with mixed features if appropriate
Building block of Bipolar II disorder and Bipolar I disorder
Essentials Features of Major Depressive Disorder{Single Episode}{Recurrent}
The px has {one} {or more} major depressive episodes and no spontaneous episodes of mania or hypomania.
-Two months or more without sxs must intervene for episodes to be counted as separate.
MDD affects about 7% of general population, with females 2:1.Usually begins in the middle to late 20s but it can occur at any time of life from childhood to old age.Onset may be sudden to gradual. Although an episode can last on average from 6 to 9 months the range can be from weeks to years.Recovery varies also from person to person.Strongly hereditary; first degree relatives have a risk several times that of general population.
Some pxs have single episode in their lifetime with no MDD; however some pxs have episode with MDD with half having another episode. If so, recurrent episodes then every 4 yrs, more increase likelihood of suicide attempts.Completion rates of pxs with MDD is 4%.
25% of pxs with MDD will experience a manic or hypomanic episode and may change their dx to bipolar I or II disorder.
Essential Features of Bipolar I Disorder
Cyclic mood disorder that includes at least One Manic Episode.
Men and women equally affected
1% of general adult population and strongly hereditary
First, to count as a Bipolar one episode, It must either represent a change of polarity(from major depressive to manic or hypomanic episode) or it must be separated from the previous episode by a normal mood that lasts at least 2 months. Second, a manic or hypomanic episode will occasionally seem to be precipitated by the tx of a depression.Antidepressant drugs, ECT, or bright light may cause a px to move rapidly from depression into a full-blown manic episode. Bipolar I disorder is defined by the occurrence of spontaneous depressions, manias, and hypomanias; therefore, any treatment-induced manic or hypomanic episode can only be used to make the dx of bipolar I (or bipolar II) condition if the sxs persist beyond the physiological effects of that tx. DSM-5 demand the full # of manic and hypomanic sxs, not just edginess or agitation that some pxs experience following tx of depression.Note: mood episodes must not be superimposed on psychotic disorders such as schizophrenia spectrum disorders.Males are more likely than females to have a first episode that is manic. If the first episode is hypomanic then the dx is bipolar II disorder. Both men and women equally affected by bipolar I disorder. Usually bipolar I pxs have depressive episodes and followed by a manic episode and then a less severe hypomanic episode.Bipolar I usually have most manic episodes and few depressive episodes these are group of pxs at higher risk for completing suicide.
Older patients who develop a mania for the first time may have a comorbid neurological disorder. they may also have a higher mortality.-Unspecified Bipolar Disorder. versus a recurrent mania in other older adults with recurrent mania.
Pxs of Bipolar I need careful interview of sxs of addiction to alcohol. Alcohol use is diagnosed as a comorbid disorder as many as 30%.
Essential features for Bipolar II Disorder
The px has had at least one each of a major depressive episode and a hypomanic episode, BUT no manic episodes ever. Never requires hospitalization and never involves psychosis.
Women may be more prone than men to develop bipolar II; fewer than 1% of general population are affected, though prevalence of adolescence may be higher. The peripartum period may precipitate an episode of hypomania.
Comorbidity-anxiety and substance use disorders, exting disorders common in females
Bipolar II pxs are ill longer and spend more time in the depressive phase than bipolar I pxs. Bipolar II may be more likely to make impulsive suicide attempts.And not a few (in the 10% range) will eventually experience a full-blown manic episode.
Distress or disability-work/educational, social, or personal impairment, but only for depressive episodes or for switches between episodes
Differential dx-Substance use and physical disorders, other bipolar disorders, major depressive disorders
Specify current or most recent episode as {hypomanic}{depressed}
Choose any relevant specifiers, for most recent episode, you can mention severity, mild, moderate, severe-choice
Essential features of Persistent Depressive Disorder(Dysthymia)
Depressed sxs persist most of the time for 2 years(they are never absent for longer than 2 months). Some pxs aren’t even aware that they are depressed though others can see it. They will acknowledge sxs as: fatigue, problems with concentration or decision making, poor self-image, and feeling hopeless. Sleep and appetite can be either increased or decreased. They may meet full requirements for a major depressive episode but the concept of mania is foreign to them.
For children and adolescents, mood may be irritable rather than depressed and time requirement is 1 year rather than 2 years.
6% of adults have dysthymia, w/women about twice as often as men, late onset uncommon.
Distress and disability-work/educational,social, or personal impairment
Differential Dx-substance use, physical disorders, ordinary grief and sadness, adjustment to a long-standing stressor, bipolar disorders, major depressive disorders
Specify severity
Specify onset-early-before age 20
late onset-begins at age 21 or later
Specify–With pure dysthymic syndrome-not meet MDD criteria
With persistent major depressive episode- does not meet criteria through preceding 2 years
With intermittent MD episodes,with current episodes.-meets MD criteria now, but at times hasn’t.
With intermittent major depressive episodes,without current episode. Has met major depressive criteria in the past, though doesn’t currently.
Essential features of Cyclothymia
Pxs are either elated or depressed but for the first couple of years, they do not fulfill the criteria for a manic, hypomanic or major depressive disorder. Dysphoric, occasionally shifting into hypomania for a day or so. Others can shift several times in a single say. Often presentation is mixed.
Typically beginning gradually in adolescence or young adulthood, it affects 1% of general population. affects gender same but women seek out treatment more, usually when depressed.Once begun, it tends toward chronicity.
Can’t have dx of Cyclothymia simultaneously with bipolar or MDD.
Duration-2years or more; children& adolescents 1 year+
Impairment-distress or disability-work/edu,social, personal
Differential dx-substance use, physical disorders, other bipolar disorders
Essential features of Premenstrual Dysphoric Disorder
20% of women in the reproductive age are affected
Severe form affects 7% of women often beginning in the teenage years, these sxs appear for perhaps a few days or a week before each menstrual cycle. Complaints: dysphoric mood, anxiety, anger, fatigue, trouble concentrating,loss of interest, feeling out of control, muscle pain, changes in appetite or sleep, sensitivity of breasts, weight gain, and abdominal swelling or distention. Shortly after menstruation begins, she snaps back to normal.
Differentiation from major depressive episode and dysthymia relies on timing and duration.
15% attempt suicide
Risk factors for PDD include excessive weight, stress, and trauma(hx of abuse), genetic component. Comorbid are anxiety disorders, mood disorders, including bipolar conditions.
Duration-for several days around menstrual periods, for most cycles during the past year
Distress or disability-social, occupational or personal impairment
Differential Dx: Substance use-including hormone replacement therapy; physical disorders; major depressive disorder or dysthymia; ordinary grief/sadness
DSM5 says that dx can only be stated as (provisional) until you’ve obtained prospective ratings of two menstrual cycles.
Essential features of Disruptive Mood Dysregulation Disorder
New in DSM5, dysruptive mood dysregulation disorder(DMDD) showcases extremes of childhood.
Children ages 6 to 17 years of age
Criteria: Temper outbursts—screaming or actually attacking someone or something–that are inappropriate for the patient’s age and stage of development. Between outbursts the child is angry, grumpy, or sad. Occurring consistently, overreacting to common stressor, no manic episodes frequency on average 3+ times a week for at least 12 months, never absent longer than 3 months, starting before age 10(dx can only be made from ages 6 to 17)
Underlying persistent irritability observed in at least 2 out of 3 settings (home, school, peers)
80% of children with DMDD also qualify for Oppositional Defiant Disorder but only diagnose DMDD.DMDD more common in boys.Alternative to Bipolar I disorder.
Differential Dx:Substance use and physical disorders, major depressive disorder, bipolar disorders, oppositional defiant disorder, attention-deficit/hyperactivity disorder, behavioral outbursts consistent with developmental age
Essential features of Panic Disoder
Unexpected panic attacks-fear, stark terror, begins suddenly and is accompanied by a variety of classic “fight or flight” sxs, plus chest pain, chills, feeling too hot, chocking, shortness of breath, rapid or irregular heartbeat, tingling or numbness, excessive perspiration, nausea, dizziness, and tremor. May feel unreal or be afraid that are losing their minds or dying. At least 4 somatic sensations are required.
Worried that will have another panic attack;usually uncued
Typically begins during pxs early 20s, found in 1-4% of general adult population(10-11% for panic attacks in general)
Common among women.Avoidance of places where attacks have occurred.
Duration-1+months
Differential Dx:substance use and physical disorders, other anxiety disorders, mod and psychotic disorders,OCD,PTSD, actual danger
Panic attacks can occur in several Medical conditions such as actute myocardial infarction, low blood sugar, irregular heartbeat, mitral valve prolapse, temporal lose epilepsy, and a rare adrenal gland tumor called phenochromocytoma.
Panic attacks also occur during intoxication with several psychoactive substances including amphetamines, marijuana, and caffeine. Note some pxs misuse alcohol and sedative drugs to reduce severity of panic attacks.
Essential feature of Panic Attacks as a specifier for any mental disorder
Panic attacks can be used as a specifier for ANY mental disorder, anxiety or other mental disorder(depressive disoder, substance abuse,etc), and some medical conditions.
There are limited sx attacks-fewer than 4 physical and/or cognitive sxs
2 types of panic attacks:expected (obvious cue or trigger)and unexpected attacks(no obvious cue or trigger), one type of unexpected attack is Nocturnal attack-waking from sleep in a state of panic.
Panic disorder has panic attacks as an integral sx listed in its criteria.Therefore, this specifier would not be used with the dx of panic dx.
Essential features of Agoraphobia
Fear some people have of a situation or place where escape seems difficult or embarrassing or where help might be unavailable if anxiety sxs should occur. Open or public places such as theaters and crowded supermarkets qualify, so does travel from home. Persons with agoraphobia either avoid the feared place or situation entirely, or if they must confront it, suffer intense anxiety or require the presence of a companion.Agoraphobia usually involves such situations as being away from home; standing in a crowd; staying home alone; being on a brigde; or traveling by bus, car or train.
Agoraphobia can develop rapidly within just a few weeks with or without panic attacks causing the px to avoid leaving home or participating in other activities.
prevalence rates 1-2%, women more susceptible, onset in the teens or 20s, some have first sx at age 40. strongly heritable.
Duration: 6+ months
Disability/distress:work/edu, social, personal impairment
Differential Dx: Substance use, physical disorders, other anx disorders, mood and psychotic disorders, OCD, PTSD, social and separation disorders, situational phobias, panic disorder
Agoraphobia-the perceived danger emanates from the environment
vs.
Social anxiety-fear comes from the relationship from other people
Separation Anxiety Disorder-fear of being left alone
Essential features of Specific Phobia
A specific situation or thing habitually causes immediate, inordinate and unreasonable dread or anxiety that the px avoids it or endures it with much anxiety.Best recognized are phobias of animals, blood, heights, travel by plane, being closed in, and thunderstorms. The anxiety produced by exposure to one of these stimuli may take the form of a panic attack or of a more generalized sensation of anxiety, but it is always directed to something specific. The closer they are to feared stimuli the worse they feel. Usually px have more than one specific phobia. Px with specific phobias involving blood, injury or injection often experience what is called vasovagal response–this means that reduced heart rate and blood pressure actually do cause the patients to faint.
Up to 10% of US adults have a specific phobia.
Onset is usually in childhood or adolescence; onset of animal phobias begin early on. Women outnumber men 2:1.
Duration: 6+months
Distress/disability:work/edu, social or personal impairment
Differential dx:substance use, physical disorders,agoraphobia,social anx disorder, separation anx disorder, mood and psychotic disorders, anorexia nervosa, OCD, PTSD
Specify:
Animal type(snakes, spiders)
Natural environment type(thunderstorms,heights)
Blood-injection-injury-type(syringes,operations)
Blood
Injections and transfusions
Other medical care
Injury
Situational type(traveling by air, being closed in)
Other type(situations where the person could vomit or choke; for children, loud noises or people wearing costumes)
Essential Features of Social Anxiety
Inordinate anxiety is attached to circumstances where others could closely observe the px–public speaking or performing,eating or having a drink, writing, perhaps just speaking with another person, playing a musical instrument, chocking when eating in public, or using a urinal.Because these activities almost always provoke disproportionately fear of embarrassment or social rejection, the px avoids these situations or endures them with much anxiety.
Px have noticeable physical sxs: blushing, hoarseness, tremor, and perspiration.Some may have panic attacks. Children may express anxiety by clinging, crying, freezing, shrinking, back, throwing tantrums, or refusing to speak.
Occurrence ranges from 4-13% in lifetime, men outnumber women in tx settings, however in general population women predominate samples. Onset is middle teens
Sxs of Social Anxiety overlap with Avoidant Personality Disorder, however Avoidant personality disorder is more severe, both begin early, tend to last for years, some commonalities in family history. Social Anxiety is reported to have a genetic basis.
Duration:6+months (for adults and children)
For children, these “others” must include peers, not just adults
Distress/Disability:work/edu, social, personal impairment
Diff dx: sub use&physical disorders, anorexia nervosa, OCD, Avoidant Per Dis, Normal shyness, and other anx disorders-especially agoraphobia.
Specify: Performance Only. The px fears public speaking or performing but not other situations.
Taijin Kyofusho(e.g., in Japan and Korea) syndrome
characterized by social evaluative concerns, fulfilling criteria for social anxiety disorder(p.205, DSM-5) that are associated with the fear that the individual makes other people uncomfortable(e.g., “My gaze upsets people so they look away and avoid me”), a fear that is at times experienced with delusional intensity. This sx may be also found in non-Asian settings.
Other presentations of taijin kyofusho may fulfill criteria for body dysmorphic disorder or delusional disorder.
Essential Features of Selective Mutism Disorder
DSM-5 classifies it as an anxiety disorder that affects children during preschool years ages 2 to 4 years old. Despite speaking normally at other times, the px regularly doesn’t speak in certain situations where speech is expected, such as in class.
Note: The first month of a child’s first year in school is often fraught with anxiety;exclude behaviors that occur during this time.
Duration:1+ months
Distress/disability:Social or work/academic impairment
Diff dx: unfamiliarity w/language to be used, a communication disorder such as stuttering, psychotic disorders, autism spectrum disorder, social anxiety disorder
Prevalence 1 in 1,000, affects gender equally
Fam hx pos. for social anx and selective mutism
comorbidity-separation anxiety and social anx, not tend to have externalizing disorders(Oppositional Def or Conduct Def Dis)
Essential Features for Separation Anxiety Disorder
Fear what might happen to a parent or someone else important in their lives, these pxs resist being alone. They imagine the parent will die or become lost(or that they will) so that even the thought of separation can cause anxiety, nightmares, or perhaps vomiting spells or other physical complaints. They are reluctant to attend school, go out to work, or sleep away from home–even in their own beds.
Duration:6+months in adults, though extreme sxs-such as total school refusal-could justify dx after a shorter duration; 4+ weeks in children
Distress/disability: work/edu, social or personal impairment
Diff dx: mood disorders, other anx disorders, PTSD
lifetime Prevalence 4% children; 6% adults
12 month adult prevalence:2%
When the onset is in childhood the condition is likely to remit; with later onset, sxs con’t into adulthood and are more severe disability-wax and wane.Most adults and children also have other disorders(especially mood, anx, sub use disorders) though separation anx disorder is often the condition present the longest. Children with Separation Anx Disorder often have an adult parent of the same disorder, as with most anx disorders, there is a Strong genetic component.
Essential Features of Generalized Anxiety Disorder
Hard to control, excessive worrying about a variety of issues—health, family problems, money, school, work—results in physical and mental complaints: muscle tension, restlessness, becoming easily tired and irritable, experiencing poor concentration, and trouble with insomnia.
Duration: on most days for 6+months
Distress/disability: work/edu, social, or personal impairment
Diff dx: substance use and physical disorders, mood disorders, other anxiety disorders, OCD, PTSD, realistic worry
nervousness is low-key and chronic, no panic attacks
Onset age 30, 9% of general adult population, women predominate
Genetic factors.
Essential features of Obsessive Compulsive Disorder
Px has distressing obsessions or compulsions (or both) that occupy so much of their time they interfere with accustomed routines.
Obsessions are recurring, unwanted ideas that intrude into awareness;the px usually tries to suppress, disregard, or neutralize them.
Compulsions are repeated physical(sometimes mental) behaviors that follow rules (or respond to obsessions) in an attempt to alleviate distress; the px may try to resist them. The behaviors are unreasonable,meaning that they don’t have any realistic chance of helping the obsessional distress.
Note: That a repeated thoughts can themselves sometimes be compulsions if their purpose is to reduce the obsessional anxiety.
4 major Sx patterns:
1.Fear of contamination which leads to 2.excessive handwashing
3.Doubts lead to 4.excessive checking:the px returns to repeatedly to be sure something is turned off(cooktop)
Obsessions about symmetry commonly occur(counting, putting things in order),and forbidden thoughts(sacrilegious ideas, sexual taboos).
Distress or disability:Typically, the obsessions and/or compulsions occupy an hour a day or more or cause work/educational,social, or personal impairment
Diff dx: substance use and physical disorders, “normal” superstitions and rituals that don’t actually cause distress or disability, depressive and psychotic disorders, anxiety and impulsive-control disorders, Tourett’s disorder, obsessive-compulsive personality disorder. Comorbidity:2/3 experience MDD, 15% attempt suicide, women and men affected equally.prevalence 2% gen pop, higher in higher SES and individuals higher intelligence.Strong familial(risk for first degree relatives 12% about 6 times normal) at least part inherited. Onset in adolescence (males) or young adulthood(females).When it begins before puberty, compulsions may start first, often accompanied by tics and comorbid disorders.
Specify degree of Insight:
With good or fair insight. The px realizes that the OCD thoughts and behaviors are definitely (or probably) not true.
With poor Insight. The px thinks the OCD concerns are probably true
With absent insight/delusional beliefs. The px strongly believes that the OCD concerns are true.
**Note: Poor Insight indicates worse prognosis.
Specify if:
Tic related.The px has a lifetime hx of a chronic tic disorder
