diagnostic criteria and rating scales Flashcards
1
Q
DSM 5 criteria for catatonia
A
In DSM-5, criteria for catatonia are met when the clinical picture is dominated by at least three of the following [2]:
●Stupor (decreased psychomotor activity or decreased reactivity to the environment)
DSM 5 criteria for catatonia
●Catalepsy (passively allowing the examiner to position the body or a body part)
●Waxy flexibility (slight, even resistance to positioning by the examiner, as in bending a candle)
●Mutism (lack of verbal response; not applicable to patients with an established aphasia)
●Negativism (motiveless resistance to instructions or external stimuli)
●Posturing (voluntarily maintaining a position of the body or a body part against gravity for a long time)
●Mannerisms (odd movements)
●Stereotypy (repetitive movements that are not goal directed and often are awkward or stiff)
●Agitation or excessive motor activity that is purposeless and not influenced by external stimuli
●Grimacing
●Echolalia (mimicking another person’s speech)
●Echopraxia (mimicking another person’s movements
2
Q
Rating scales for catatonia
A
Bush Francis scale 23 items
3
Q
Rating scales for suicidal ideations
A
Columbia suicide severity scale
4
Q
Diagnostic criteria for intellectual disability
A
Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.
need three criteria:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract
thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life,
such as communication, social participation, and independent living, across multiple
environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
5
Q
Specifier for intellectual disability
A
Mild
Moderate
Severe
Profound
6
Q
Intellectual disability
prevalence
which gender
most common co-occurring (4)
A
prevalence 1%
more likely in male
most common co occurring are ADHD, depressive and bipolar, anxiety, ASD, impulse control disorder and major neurocognitive disorder
7
Q
diagnostic criteria for autistic spectrum disorder
A
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at
least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,
strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects,visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become
fully manifest until social demands exceed limited capacities, or may be masked by
learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
8
Q
Specifier for ASD
A
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
9
Q
rating scales for ASD
A
childhood autism rating scale (CARS) 15 to 60
The Autism Spectrum Rating Scales (ASRS™) (2-18 years old)
Autism Diagnostic Observation Schedule (ADOS)
The Autism Spectrum Quotient (AQ-10) tool is recommended for use with adults with possible autism who do not have a moderate or severe ASD
10
Q
Rating scales for ADHD
A
Conners Abbreviated Symptom Questionnaire
Vanderbilt Assessment Scales
SNAP-IV 26-Item Teacher and Parent Rating Scale
Diagnostic Interview for ADHD in adults (DIVA)
11
Q
DSM criteria for ADHD
A
ADHD
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details,work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and
adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older
adolescents and adults, returning calls, paying bills, keeping appointments).
- Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
12
Q
Prevalence of ADHD
A
2.5% in adults, 5% in children
13
Q
risk factors for adhd
A
-low birth weight, smoking during pregnancy, history of child abuse, neglect, multiple foster placements, neurotoxin exposure (e.g., lead), infections (e.g., encephalitis), or alcohol exposure in utero. Family history
14
Q
dsm criteria for tourette’s disorder
A
Tourette’s Disorder
A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis).
15
Q
rating scales for tourettes
A
Yale Global Tic Severity Scale (YGTSS)
Tourettes disorder scales
16
Q
PTSD rating
A
CAPS 5
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a 30-item structured interview that corresponds to the DSM-5 criteria for PTSD.
17
Q
diagnosis for bipolar disorder 1
A
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or
more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity). - Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. functional impairment or need hospitalisation
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication, other treatment) or to another medical condition.
18
Q
A full manic episode that emerges during antidepressant treatment is considered mania?
A
Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of treatment is sufficient for mania
19
Q
difference between hypomania and mania
A
diff between hypomanic
1) time line: 4 consecutive days
2) The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
3) If there are psychotic features, the episode is, by definition, manic.
20
Q
Criteria for depression
A
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1) pervasive depressed mood/(irritable mood for children and adolescent)
2) anhedonia
3) poor sleep
4) poor or inc in appetite or loss of weight of 5% in a month
5) psychomotor retardation
6) neg cognition of guilt
7) suicidal ideation
8) poor concentration/indecisiveness
9) Loss of energy
21
Q
things need for diagnosis of bp1 and bp2
?need manic/depressive episode
A
diagnosis for bipolar disorder
has one manic episode
for bipolar 2 disorder
need to have one hypomanic and at least one MDD episode
22
Q
Difference in bipolar 1 and 2 in terms of development
A
Difference in bipolar 1 and 2 in terms of development
Bipolar 2 develop slightly later than bipolar 1 but earlier than MDD
Number of lifetime episode tends to be higher for bp2
bipolar 1 is equal in gender, bipolar 2 is in more common in females
23
Q
Specifier for MDD/bipolar (11)
A
specifier for bipolar/depression: with psychotic features With anxious distress With mixed features With rapid cycling With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern
24
Q
Criteria for cyclothymic
A
A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for
a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the hypomanic
and depressive periods have been present for at least half the time and the individual
has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
25
what are the main criterion for Substance/Medication-Induced Bipolar and Related Disorder
Substance/Medication-Induced Bipolar and Related Disorder: symptoms develop during or soon after substance intoxication or withdrawal or after exposure to a medication
The meds/substance is capable of producing the symptoms
26
What is the specifier for Bipolar and Related Disorder Due to Another Medical Condition
What is the specifier for Bipolar and Related Disorder Due to Another Medical Condition
with manic features, with manic or hypomanic like episode, with mixed features
27
specifier for anxious distress
2 out of 5
1) key up or tense
2) unusually restlessness
3) Diff concentrating
4) fear that something awful may happen
5) may lose control of oneself
28
Diagnosis criteria with mixed features
| mania/hypomania episode with mixed features
```
eg: manic or hypomania episode with mixed features
full criteria for mania/hypomania then 3 of 6 depressive symptoms
1) low mood
2) anhedonia
3) low energy
4) suicidal ideation
5) neg cognition
6) psychomotor retardation
```
29
Specifier with mixed features
| Depressive episode with mixed features
full criteria for MDD with 3/7
1) fill elevated, expansive mood
2) inc sense of self
3) talkativeness
4) racing thoughts
5) inc goal directed activities
6) involvement in activities that has high potential of painful consequences
7) dec need for sleep
30
criteria for rapid cycling
Rapid cycling
1) 4 episode in 12 months
2) need to be switch in opposite polarity
3) need 2 months of full remission in between
31
Criteria for melancholic
```
With melancholic features:
1) 1 in 2
-lack of pleasure in activities
-lack of reactivity to usually pleasurable stimuli
B) 3 in 6
1) early morning awakening
2) poor appetite
3) depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
4) psychomotor retardation/agitation
5) depression worse in the morning
6) Guilt ++
```
32
Criteria for atypical features
```
With atypical features
A) mood reactivity
B) two of 4
1) sig weight gain
2) hypersomnia
3) leadan paralysis
4) long standing pattern of interpersonal rejection sensitivity
```
33
Timeline for peripartum onset
Timeline for peripartum onset
| -during pregnancy or 4 weeks after delivery
34
Dissociative Identity disorder criteria
Dissociative Identity disorder
A) disruption of identity characterized by two or more distinct personality. Marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory motor functioning. May be observed by self or reported by the individual
B. Recurrent gaps of everyday events, important personal information and/or traumatic event
C. caused significant distress or impairment in social, occupational or other important areas of functioning
D. Not normal part of a broadly accepted cultural or religious practice
E. Not attributable to effects of substance or medical condition
35
Dissociative amnesia
what is the specifier
Dissociative amnesia
1) inability to recall important autobiograpical information, usually of a traumatic or stressful nature, tat is inconsistent with ordinary forgetting
2) significant distress or impairment in social occupational or other functioning
3) not attributable to substances, neurological or medical condition
4) not better explained by DID, PTSD, Acute stress disorder, Somatic symptoms disorder
Specifier: with or without dissociative fugue (apparently purposeful travel or bewildered wandering with that is associated with amnesia for identity)
36
Criteria for depersonalization/derealization disorder
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g.,
perceptual alterations, distorted sense of time, unreal or absent self, emotional and/
or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder
37
specifier for adjustment disorder (6)
1) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
2) With anxiety: Nervousness, worry, jitteriness, or separation anxiety
is predominant.
3) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
4) With disturbance of conduct: Disturbance of conduct is predominant.
5) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
6) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
38
Adjustment disorder criteria
Adjustment disorder
A. The development of emotional or behavioral symptoms in response to an identifiable
stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of
the following:
1. Marked distress that is out of proportion to the severity or intensity of the stressor,
taking into account the external context and the cultural factors that might influence
symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder
and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated, the symptoms do not persist
for more than an additional 6 months.
39
Acute stress disorder criteria
acute stress disorder
A) expose to actual r threatened death, serious injury or sexual violation
B) have 9 or more in the 5 category
i) intrusion: 1) intrusive memories 2) dreams 3) dissociative reaction (flashback) 4) intense distress to internal / external cues of the event
ii) neg mood: 5) unable to experience positive symptoms
iii) dissociative symptoms: 6) altered sense of the reality of one's surroundings or oneself 7) amnesia of the events
iv) avoidance: 8) effort to avoid memories/thoughts 9) efforts to avoid external reminders
v) Arousal 1) sleep disturbance 11) irritable behavior 12) hypervigilance 13) problems with concentration 14) exaggerated startle response
C) 3 days to 1 month after the trauma
D) distress to functioning
E) not due to substance, medical condition, brief psych disorder
40
disruptive mood dysregulation disorder
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age at onset of Criteria A–E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a
highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder
and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others
41
Prevalence
| of depression and anxiety in sg
Prevalence
Depression 8.7% in SG
Anxiety
9.4% in SG
42
Persistent depressive disorder criteria
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least
1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
43
Specifier for Persistent depressive disorder
Specify if (for most recent 2 years of persistent depressive disorder):
With pure dysthymic syndrome: Full criteria for a major depressive episode have not
been met in at least the preceding 2 years.
With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode.
With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
44
Premenstrual Dysphoric Disorder
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total
of five symptoms when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a
sensation of “bloating,” or weight gain.
Note: The symptoms in Criteria A–C must have been met for most menstrual cycles that
occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with
work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely an exacerbation of the symptoms of another disorder,
such as major depressive disorder, panic disorder, persistent depressive disorder
(dysthymia), or a personality disorder (although it may co-occur with any of these disorders).
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).
45
Specifier for Depressive Disorder
| Due to Another Medical Condition
With depressive features: Full criteria are not met for a major depressive
episode.
With major depressive–like episode: Full criteria are met (except Criterion C) for a major depressive episode.
With mixed features: Symptoms of mania or hypomania are also present but do not predominate in the clinical picture
46
Criteria for selective mutism
```
A. Consistent failure to speak in specific social situations in which there is an expectation
for speaking (e.g., at school) despite speaking in other situations.
```
B. The disturbance interferes with educational or occupational achievement or with social communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of
school).
D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder
47
Specific phobia
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals,
receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing,
or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object
or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder,
including fear, anxiety, and avoidance of situations associated with panic-like symptoms
or other incapacitating symptoms (as in agoraphobia); objects or situations related to
obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in
posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
48
rating scales for selective mutism
selective mutism questionaire
| SMQ is a parent rating scale
49
Criteria for social anxiety disorder
A. Marked fear or anxiety about one or more social situations in which the individual is
exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation
and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum
disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns
or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
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Social anxiety disorder rating scales
The Liebowitz Social Anxiety Scale (LSAS) is a 24-item, self-rated scale
51
Specifier for social anxiety
Performance only: If the fear is restricted to speaking or performing in public.
52
Panic Disorder criteria
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear
or intense discomfort that reaches a peak within minutes, and during which time four
(or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or “going crazy.”
13. Fear of dying
B. At least one of the attacks has been followed by 1 month (or more) of one or both:
1. Persistent concern or worry about additional panic attacks or their consequences
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors
designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar
situations)
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder
53
rating scales for panic disorder
Panic Disorder Severity Scale (PDSS) clinician rated
- is intended to assess severity and considered a reliable tool for monitoring of treatment outcome.
Theres a self reported version PDSS-SR
Panic and Agoraphobia Scale (PAS) is primarily used for monitoring the efficacy of both medication and psychotherapy treatments of agoraphobia, as well as a screening tool for the disorder
54
Agoraphobia criteria
A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other capacitating or embarrassing symptoms
C. The agoraphobic situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion,
or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic
situations and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
H. If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease)
is present, the fear, anxiety, or avoidance is clearly excessive.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder
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GAD criteria
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the
past 6 months):
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
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Factitious Disorder Imposed on Another
Factitious Disorder Imposed on Another
(Previously Factitious Disorder by Proxy)
A. Falsification of physical or psychological signs or symptoms, or induction of injury or
disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional
disorder or another psychotic disorder.
Note: The perpetrator, not the victim, receives this diagnosis.
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Factitious disorder on self
Factitious Disorder Imposed on Self
A. Falsification of physical or psychological signs or symptoms, or induction of injury or
disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional
disorder or another psychotic disorder.
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Conversion
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
59
Illness anxiety disorder
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another mental disorder, such
as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.
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Specifier for illness anxiety disorder
Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
Care-avoidant type: Medical care is rarely used
61
Somatic symptom disorder
Specifier
Somatic symptom disorder
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specifer: With predominant pain
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Scale for Anxiety (4)
Zung Self-Rating Anxiety Scale
Hospital Anxiety and Depression Scale
Hamilton Anxiety Scale (HAM-A) clinical rated
Beck Anxiety Inventory
63
Eating disorder scale
Eating Attitudes Test (EAT-26)
Eating Disorder Inventory (EDI)
Binge Eating Scale (BES)
Anorectic Behavior Observation Scale (ABOS) is a thirty-item diagnostic questionnaire devised to be answered by the parents, spouse or others
64
Anorexia nervosa and its specifier
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior
65
Eating disorder comorbids
Bipolar, depressive, and anxiety disorders commonly co-occur with anorexia nervosa
OCD
Alcohol use and drug use disorder
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Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period
of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa
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Binge Eating disorder
A. Recurrent episodes of binge eating. An episode of binge eating is characterized
by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of
time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
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Avoidant/Restrictive Food Intake Disorder
A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or oral nutritional supplements.
4. Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder.
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Obsessive Compulsive Disorder criteria
Obsessive Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excess
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects
of a substance
D. The disturbance is not better explained by the symptoms of another mental disorder
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Specifier for OCD
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
With absent insight/delusional beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Tic-related: The individual has a current or past history of a tic disorder
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Rating scales for OCD
The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) (clincian rated)
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Criteria for Body dismorphic disorder
Body dismorphic disorder
A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
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Specifier for Body dysmorphic disorder
Specifier:
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
Specify if:
Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly” or “I look deformed”).
With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true
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Rating scales for Body dysmorphic disorder
The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) is a semi-structured, clinician-rated measure of current BDD
75
Hoarding criteria
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated
with discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that
congest and clutter active living areas and substantially compromises their intended
use. If living areas are uncluttered, it is only because of the interventions of third parties
(e.g., family members, cleaners, authorities).
D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder
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Rating scales for Hoarding
ICD® Clutter–Hoarding Scale®
The Hoarding Rating Scale is a brief 5-item scale that can be given as a semi-structured clinician interview or as a questionnaire. This tool includes 5 questions about clutter, difficulty discarding, excessive acquisition, and the resulting distress and impairment caused by hoarding.
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Voyeuristic disorder criteria
Voyeuristic disorder
a) over period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in process of disrobing or engaging in sexual activity, as manifested by fantasies, urges, or behavior
b) Act on these sexual urges with a non consenting person or the sexual urges or fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
c) at least 18 years old
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Prevalence of voyeuristic disorder
Highest possible lifetime prevalence for voyeuristic disorder is approximately 12% in males and 4% in female
79
Exhibitionist disorder + specifier
Exhibitionistic disorder
A) over period of at least 6 months, recurrent and intense sexual arousal from exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behavior
B) TO act with a non consenting person, or fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
Specifier:
Sexually aroused by exposing genitals to prepubertal children
Sexually aroused by exposing genitals to physically mature individuals
Sexually aroused by exposing genitals to pubertal children and to physically mature individuals
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Frotteuristic Disorder criteria
Frotteuristic Disorder
A. over the period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non consenting person, as manifested by fantasies, urges, or behavior
B. To act with a non consenting person, or fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
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Sexual masochism Disorder criteria and specifier
A. over period of at least 6 months, recurrent and intense sexual arousal from act of being humiliated, beaten, bound or otherwise made to suffer, as manifested by fantasies, urges, or behavior
B. fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
Specifier: with asphyxiophilia: aroused in related to restriction of breathing
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Sexual sadism disorder criteria
Sexual sadism disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from physical or psychological suffering of another person as manifested by fantasies urges or behaviors
B. To act with a non consenting person, or fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
83
Pedophillic disorder criteria and specifier
Pedophilic disorder
A. over a period of at least 6 months, recurrent, intense sexually rousing fantasies, sexual urges, or behaviors involving sexual activities with a prepubescent child or children (generally 13 years or younger)
B. These individual has acted on these sexual urges or fantasies caused clinically significant distress or interpersonal difficulty
C. These individual is at least 16 years and at least 5 years older than the child/children in criterion A
Specify:
Exclusive type
Nonexclusive type
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both
Limited to incest
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Fetishistic Disorder criteria and specifier
Fetishistic Disorder
Over 6 months, recurretn and intense sexual arousal from using non living objects or a higher specific focus on non genital body parts, as manifested by fantasies, urges or behvaiours
B. fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
C not limited to clothing used in cross dressing or deviced designed for tactile genital stimulation (vibrator)
Specify:
body part, non living objects, other
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Transvestic Disorder criteria and specifier
Transvestic Disorder
A. Over the period of at least 6 months, recurrent and intense sexual arousal from cross dressing, as manifested by fantasies, urges or behavior
B. fantasies caused clinically significant distress or impairment in social, occupational or other important areas of functioning
Specifier:
With fetishism: if sexually aroused by fabrics, materials or garments
With autogynephilia, if sexually aroused by thoughts or images of self as female
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Delusion disorder
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met.
Note: Hallucinations, if present, are not prominent and are related to the delusional
theme (e.g., the sensation of being infested with insects associated with delusions of
infestation).
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly
impaired, and behavior is not obviously bizarre or odd.
D. If manic or major depressive episodes have occurred, these have been brief relative
to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such
as body dysmorphic disorder or obsessive-compulsive disorder.
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Delusion disorder specifier
Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.
Jealous type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful.
Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in
the pursuit of long-term goals.
Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.
Mixed type: This subtype applies when no one delusional theme predominates.
Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).
With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not
understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars).
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Schizoaffective disorder criteria
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1: Depressed mood.
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse,
a medication) or another medical condition.
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Gender Dysphoria in children criteria
A. A marked incongruence between one’s experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as manifested by at least six of the following
(one of which must be Criterion A1):
1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine
clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games,
and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match
one’s experienced gender.
B. The condition is associated with clinically significant distress or impairment in social,
school, or other important areas of functioning.
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specifier with gender dysphoria
With a disorder of sex development
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Gender Dysphoria in Adolescents and Adults criteria
A. A marked incongruence between one’s experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as manifested by at least two of the following:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
B. The condition is associated with clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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Major cognitive impairment criteria
A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as
paying bills or managing medications).
C. The cognitive deficits do not occur exclusively in the context of a delirium
D. The cognitive deficits are not better explained by another mental disorder (e.g., major
depressive disorder, schizophrenia)
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Specifier for DSM (13) for major Neuro cognitive disorder
```
Alzheimer’s disease
Frontotemporal lobar degeneration
Lewy body disease
Vascular disease
Traumatic brain injury
Substance/medication use
HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease
Another medical condition
Multiple etiologies
Unspecified
```
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Alzheimer's disease criteria Major or Mild
A. The criteria are met for major or mild neurocognitive disorder.
B. There is insidious onset and gradual progression of impairment in one or more cognitive
domains (for major neurocognitive disorder, at least two domains must be impaired).
C. Criteria are met for either probable or possible Alzheimer’s disease as follows:
For major neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.
1. Evidence of a causative Alzheimer’s disease genetic mutation from family history
or genetic testing.
2. All three of the following are present:
a. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).
b. Steadily progressive, gradual decline in cognition, without extended plateaus.
c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or
cerebrovascular disease, or another neurological, mental, or systemic disease
or condition likely contributing to cognitive decline).
For mild neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.
Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all
three of the following are present:
1. Clear evidence of decline in memory and learning.
2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely
contributing to cognitive decline).
D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.
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Frontotemporal Neurocognitive Disorder
| criteria
A. The criteria are met for major or mild neurocognitive disorder.
B. The disturbance has insidious onset and gradual progression.
C. Either (1) or (2):
1. Behavioral variant:
a. Three or more of the following behavioral symptoms:
i. Behavioral disinhibition.
ii. Apathy or inertia.
iii. Loss of sympathy or empathy.
iv. Perseverative, stereotyped or compulsive/ritualistic behavior.
v. Hyperorality and dietary changes.
b. Prominent decline in social cognition and/or executive abilities.
2. Language variant:
a. Prominent decline in language ability, in the form of speech production, word
finding, object naming, grammar, or word comprehension.
D. Relative sparing of learning and memory and perceptual-motor function.
E. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.
Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; otherwise, possible frontotemporal neurocognitive disorder should be diagnosed:
1. Evidence of a causative frontotemporal neurocognitive disorder genetic mutation, from
either family history or genetic testing.
2. Evidence of disproportionate frontal and/or temporal lobe involvement from neuroimaging.
Possible frontotemporal neurocognitive disorder is diagnosed if there is no evidence of a genetic mutation, and neuroimaging has not been performed.
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Major or Mild Neurocognitive Disorder
| With Lewy Bodies criteria
A. The criteria are met for major or mild neurocognitive disorder.
B. The disorder has an insidious onset and gradual progression.
C. The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.
For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features, or one suggestive feature with one or more core features.
For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature, or one or more suggestive features.
1. Core diagnostic features:
a. Fluctuating cognition with pronounced variations in attention and alertness.
b. Recurrent visual hallucinations that are well formed and detailed.
c. Spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline.
2. Suggestive diagnostic features:
a. Meets criteria for rapid eye movement sleep behavior disorder.
b. Severe neuroleptic sensitivity.
D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.
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Major or Mild Vascular Neurocognitive Disorder criteria
A. The criteria are met for major or mild neurocognitive disorder.
B. The clinical features are consistent with a vascular etiology, as suggested by either of
the following:
1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular
events.
2. Evidence for decline is prominent in complex attention (including processing
speed) and frontal-executive function.
C. There is evidence of the presence of cerebrovascular disease from history, physical
examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits.
D. The symptoms are not better explained by another brain disease or systemic disorder.
Probable vascular neurocognitive disorder is diagnosed if one of the following is present; otherwise possible vascular neurocognitive disorder should be diagnosed:
1. Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributed to cerebrovascular disease (neuroimaging-supported).
2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events.
3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present.
Possible vascular neurocognitive disorder is diagnosed if the clinical criteria are met
but neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one or more cerebrovascular events is not established.
98
Antisocial personality disorder criteria
. A pervasive pattern of disregard for and violation of the rights of others, occurring since
age 15 years, as indicated by three (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by
repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from another.
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
99
Studies that is landmark for bipolar
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Step bd ( systematic treatment enchantment program for bipolar disorder)
Balance (bipolar affective disorder lithium/anticonvulsant evaluation: lithium +Val > lithium mono > Val mono
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100
Screening questionnaires for bipolar
Young’s mania rating scale - clinician rated
Bdss, brief bipolar disorder symptom scale
Altman self rating mania scale ASRM - self rated 5 items
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objective measured for sleep
nocturnal polysomnography
EEG and video recording if suspect nocturnal seizures
Multiple sleep latency test for excessive daytime sleepiness
Maintenance of wakefulness test
FBC, iron (RLS), TFT, CT/MRI
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treatment for nacrolepsy:
sleep hygiene, scheduled daytime naps
Cataplexy, sleep paralysis and hypnagogic can be treated with RM suppressing antidepressant such as venlafaxine and SSRI
Can give modafinil or stimuli, gamma hydroxybutyric acid
