DSM 5 First 8 weeks

Question 1

What is a Mental State?

Answer 1

Sensorium
1. a sensory nerve center.

2. the state of an individual as regards to	 	    consciousness or mental awareness.

Question 2

Thoughts

Answer 2

ideas, concepts

Question 3

Feelings

Answer 3

subjective emotional states

Question 4

Perceptions

Answer 4

functioning of 5 senses

Question 5

Cognitions

Answer 5

abilities of intelligence, memory, attention, calculations

Question 6

Behaviors

Answer 6

actions

outward manifestations of internal mental states

Question 7

What is a Mental Disorder?

Answer 7

Thoughts delusions, thought disorder

Feelings depression, anxiety, mania

Perceptions hallucinations (5 senses)

Cognitions memory disturbance, orientation

Behaviors compulsions, violence, suicide

Question 8

Normal versus Abnormal

Answer 8

Clinically significant distress or impairment in social/occupational/relational functioning

Causes suffering

Viewed as “illness” out of the ordinary

Everyone experiences levels of suffering

Question 9

Problems in living and “mental disorders

Answer 9

Problems: difficulties of every day life

	miserable, yet differ in magnitude 		& impairment

Disorders: significant impairment

	consistent

Question 10

Symptoms & Signs

Answer 10

Symptoms: expressed subjectively

		unobservable

		must be reported

Signs: observable

		affect

		behavior

Question 11

The DSM: Descriptive vs. Explanatory

Answer 11

No theoretical explanations for psychological events

Describes & categorizes

Describes subjective experience

“Precise description and categorization of abnormal experience”

Question 12

The Diagnostic Exam

Answer 12

Introduction: how person would like to be addressed?

		set expectations; explain 				interview

		“What are you hoping to obtain 			help with?”

Listen: uninterrupted speech guides your MSE

Question 13

The Diagnostic Exam,History of Present Illness:

Answer 13

“why now”?

last time person felt emotionally well

precipitating factors; extenuating 	circumstances

perceived level of impairment

Question 14

The Diagnostic Exam,Past Psychiatric History:

Answer 14

first notice symptoms?

first sought treatment?

hospitalization; how many times, for how long?

medications; frequency/dose; effectiveness

ECT

Question 15

The Diagnostic Exam, Safety:

Answer 15

harm to self: previous attempts
history of in family

harm to others:	people
			animals
			property

threats

aggression

theft

Question 16

The Diagnostic Exam, Review of Systems

Answer 16

MOOD: have you been feeling sad, blue, irritable, depressed?

	loss of interest

	feeling different than “normal”

	periods of mood elevation

Question 17

The Diagnostic Exam:Psychosis:

Answer 17

seeing things, visions, hearing things

	people following you

	special powers: mind reading

	messages from television/radio

Question 18

The Diagnostic Exam:Anxiety:

Answer 18

past several months have you frequently worried about a number of things in your life?

	objects, places, situations

	panic or panic attacks

Question 19

The Diagnostic Exam, Obsessions & Compulsions:

Answer 19

do you frequently experience unwanted thoughts, images or urges?

any physical acts you feel you have to do?

Question 20

The Diagnostic Exam, Trauma:

Answer 20

worst thing ever happened?

		witness/experienced event in 			which self/others seriously 				injured?

		abuse?

Question 21

The Diagnostic Exam, Dissociation:

Answer 21

trouble remembering?

		loss of time

		feeling detached from body

		experiencing others as “unreal”

Question 22

The Diagnostic Exam, Somatic Concerns:

Answer 22

worry; illnesses

Question 23

The Diagnostic Exam, Eating/Feeding:

Answer 23

appearance; restrictions

Question 24

The Diagnostic Exam, Sleeping:

Answer 24

inadequate; poor quality

			lapses into; increased 					need

			unusual behaviors

			early morning wakening

Question 25

Mental Status Examination

Answer 25

``` Appearance Behavior Speech Mood Affect Thought Process {Form} Thought Content Cognition & Intellectual Resources Insight & Judgment ```

Question 26

Neurodevelopmental Disorders | first appear in early developmental periods

Answer 26

``` Intellectual Disability Assesses: cognitive capacity (IQ) adaptive functioning New Additions: Communication Disorders Autism Spectrum Disorders ``` Changes: Attention-Deficit/Hyperactivity Disorder (lifespan) Specific Learning Disorder (reading &math etc.) Inclusions: Motor Disorders

Question 27

Intellectual Disability Disorder (pg.33) 319 (ICD 9) (Intellectual Developmental Disorder; ICD terminology)

Answer 27

``` Deficits: intellectual functioning IQ 70 (two standard deviations from the mean) reasoning problem solving planning abstract thinking judgment academic learning Confirmed by assessment & standardized intelligence testing ```

Question 28

Deficits: Adaptive Functioning

Answer 28

does not meet sociocultural & developmental standards for personal independence and social responsibility limit functioning in 1 or more activities daily life communication social participation independent living Across multiple environments: school, home, work, community Onset: developmental period (before school)

Question 29

Development & Course

Answer 29

``` Onset: intellectual/adaptive deficits during developmental period age & characteristics determined by: etiology & severity of brain dysfunction ``` ``` First 2 years of life; severe intellectual disability: delayed milestones: social motor language ``` School age: mild disabilities

Question 30

Neurodevelopmental Disorders

Answer 30

Acquired (rather than genetic) form of ID: head trauma/TBI meningitis encephalitis When disability secondary to loss of previously acquired cognitive skills: may diagnose both: Intellectual Disability Neurocognitive Disorder Prevalence: 6 per 1000 Males more often diagnosed than females

Question 31

Neurodevelopmental Disorders

Answer 31

Communication Disorders Onset: childhood steady course usually lifelong functional impairment Deficits: Speech: expressive production of sounds Language: form, function & use of symbols Communication: verbal/nonverbal beha

Question 32

Social (Pragmatic) Communication Disorder | 315.39 (F80.89) page 47

Answer 32

Pragmatic language: using language appropriately (5 yrs. of age) Persistent difficulties in the social use of nonverbal/verbal communication: (all areas) deficits in communication for social reasons difficulty/inability to match communication to context or needs of the listener difficulty following conversation rules difficulties understanding inferences, metaphors

Question 33

Autism Spectrum Disorder 299.00 (F84.0) | Pg. 50

Answer 33

A. Persistent deficits in social communication/interaction across multiple settings social-emotional reciprocity nonverbal communicative behaviors developing, maintaining & understanding relationships Severity: see table 2: page 52

Question 34

Autism Spectrum Disorder, repetitive patterns of behavior, interests or activities

Answer 34

stereotyped/repetitive motor movements insistence on sameness; inflexible adherence to routines highly restricted, fixated interests; abnormal in intensity or focus hyper- or hyporeactivity to sensory input Specify severity: table 2 (page 52)

Question 35

Autism Spectrum Disorder,

Answer 35

Symptoms present in early developmental period may not manifest until social demands exceed individual capacity Clinically significant impairment in social, occupational & other areas of functioning DSM-IV-TR autistic disorder PDD-NOS Autism Spectrum Disorder Asperger’s Marked deficits in social communication; no ASD criteria: Social (pragmatic) Communication Disorder

Question 36

Attention-Deficit/Hyperactivity Disorder pg. 59

Answer 36

A persistent pattern of inattention and/or hyperactivity-impulsivity which interferes with functioning or development Inattention: 6+ sx Inattention cont. does not follow through on instructions; fails to do home work difficulty organizing tasks & activities avoids/reluctant/dislikes tasks which require sustained levels of attention looses things easily distracted forgetful + months fails to give attention to details; careless mistakes difficulty sustaining attention doesn’t seem to listen when spoken to directly

Question 37

Attention-Deficit/Hyperactivity Disorder pg. 59

Answer 37

Hyperactivity & Impulsivity: 6+ sx. 6+ mos. fidgets, taps hands/feet; squirms leaves seat in seated situations runs/climbs about when not appropriate unable to play quietly; interrupts & intrudes “on the go” “driven by a motor” blurts out answers difficulty taking turns

Question 38

Attention-Deficit/Hyperactivity Disorder

Answer 38

Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 are present in two or more settings Specifiers: pp. 58-59 Co-Occurring: language/ motor/social development delays Associated Features: irritability, mood lability; low frustration tolerance

Question 39

Attention-Deficit/Hyperactivity Disorder

Answer 39

Development: preschool: hyperactivity elementary: inattention adolescence: fidgetiness, jitteriness, restlessness, impatience More common in males More likely to develop conduct disorder > antisocial personality disorder More likely to be: injured/ more accidents obese substance use disorders

Question 40

Tic Disorders: page 81

Answer 40

Tic: sudden, rapid, recurrent, nonrhythmic motor movement or vocalization Onset: before age 18 Tourette’s Disorder: 307.23 (F95.2) Persistent (Chronic) Motor or Vocal Tic Disorder 307.22 (F95.1) Provisional Tic Disorder: 307.21 (F95.0)

Question 41

Schizophrenia Spectrum & Other Psychotic Disorders

Answer 41

schizotypal personality disorder delusional disorder brief psychotic disorder schizophreniform disorder substance/medication induced psychotic disorder psychotic disorder/another medication condition attain associated with another mental disorder catatonic disorder due to another medication condition

Question 42

Schizophrenia Spectrum & Other Psychotic Disorders,Abnormalities in one or more:

Answer 42

delusions hallucinations disorganized thinking (speech) disorganized(grossly)or abnormal behavior include catatonia negative symptoms

Question 43

Schizophrenia Spectrum & Other Psychotic Disorders Delusions

Answer 43

persecutory: fear of being harmed referential: comments/gestures >at oneself somatic: preoccupation health/organs erotomanic: other person in love with grandiose: belief of exceptional abilities nihilistic: major catastrophe will occur

Question 44

Schizophrenia Spectrum & Other Psychotic Disorders, Delusions

Answer 44

Bizarre: impossible; out of cultural realm typically involves loss of control over mind and/or body thought withdrawal thought insertion delusions of control Nonbizarre: plausible; highly unlikely

Question 45

Schizophrenia Spectrum & Other Psychotic Disorders | Hallucinations

Answer 45

Disturbance in perceptions no outside stimulus involuntary clear & vivid Auditory: most common voices (familiar or unfamiliar) separate from one’s thoughts Hypnogogic & Hypnopompic occur while falling to/waking up from sleep within range of normal experience

Question 46

Schizophrenia Spectrum & Other Psychotic DisordersDisorganized Thinking (Speech)

Answer 46

Formal thought disorder inferred by disorganized speech substantially impairs effective communication derailment/loose associations topic to topic word salad/incoherence tangential answers mildly related

Question 47

Schizophrenia Spectrum & Other Psychotic Grossly Disorganized or Abnormal Motor Behavior(Includes Catatonia)

Answer 47

Manifestations: silliness unpredictable agitation unable to perform ADLs Catatonic Behavior: decreased reactions to environmental stimuli Negativism- resists directions/instructions Mutism & stupor- lack of verbal/motor responses Catatonic excitement: purposeless & excited motor activity

Question 48

Schizophrenia Spectrum & Other Psychotic Catatonic Features

Answer 48

rigid, inappropriate or bizarre posture stereotyped movements (stereotypy) rocking; marching in place, caressing self crossing/uncrossing legs staring grimacing mutism echoing of speech

Question 49

Schizophrenia Spectrum & Other Psychotic | Negative Symptoms

Answer 49

``` Most prominent in Schizophrenia: diminished emotional expression reductions in expression: face eye contact prosody (rhythm/intonation speech) hand/head/face movements ``` avolition reduction in self-initiated activities long periods of sitting disinterest in social activities

Question 50

Schizophrenia Spectrum & Other Psychotic | Negative Symptoms

Answer 50

Alogia: reduction in speech output Anhedonia: decreased ability to experience pleasure Asociality: lack of interest in social interactions

Question 51

Schizophrenia Spectrum & Other Psychotic Disorders presented with gradient of psychopathology

Answer 51

Practitioners: consider least severe first then review time-limited conditions exclude all other conditions which may present with psychosis.

Question 52

Schizophrenia Spectrum & Other Psychotic Assessment Measures psychiatry.org/dsm5 see page 734

Answer 52

Administer at the initial client/patient interview Monitors client progress Level 1 questions: brief survey of 13 domains for adults 12 domains for child and adolescent clients Level 2 questions: more in-depth assessment of certain domains.

Question 53

Schizophrenia Spectrum & Other PsychoticSchizophrenia Spectrum & Other Psychotic Assessment Measures psychiatry.org/dsm5 see page 734

Answer 53

Severity Measures: disorder specific correspond to diagnostic criteria Review Assessment Measures page 742-743: symptom severity predicts degree of cognitive and/or neurobiological deficits ``` reviews primary symptoms of psychosis hallucinations disorganized speech disorganized behavior delusions negative symptoms ```

Question 54

Schizophrenia Spectrum & Other Psychotic | Delusional Disorder297.1 (F22)

Answer 54

Diagnostic Criteria: page 90 ``` Specify Subtypes: erotomanic grandiose jealous persecutory somatic mixed no one theme predominant unspecified dominant belief not described in types or cannot be clearly determined ```

Question 55

Schizophrenia Spectrum & Other Psychotic | Delusional Disorder297.1 (F22)

Answer 55

Specify: with bizarre content Course Specifiers: only use after 1 year duration of the disorder ``` Severity Specifiers: quantitative last 7 days assesses primary symptoms of psychosis use Assessment Measures (pp. 743-744) ```

Question 56

Schizophrenia Spectrum & Other Psychotic | Delusional Disorder

Answer 56

Specify: with bizarre content Course Specifiers: only use after 1 year duration of the disorder ``` Severity Specifiers: quantitative last 7 days assesses primary symptoms of psychosis use Assessment Measures (pp. 743-744) ```

Question 57

Schizophrenia Spectrum & Other Psychotic Delusional Disorder

Answer 57

Associated Features: factual insight; not true insight legal difficulties irritable, dysphoric mood litigious/antagonistic behavior anger & violence persecutory jealous erotomanic

Question 58

Schizophrenia Spectrum & Other Psychotic | Delusional Disorder

Answer 58

More prevalent in adults May develop schizophrenia Strong familial relationship: schizophrenia schizotypal personality disorder Functional impairment more limited relationship distress generally due to delusional beliefs behavior/appearance “normal”

Question 59

Schizophrenia Spectrum & Other Psychotic | Brief Psychotic Disorder298.8 (F23)

Answer 59

Diagnostic Criteria: page 94 Subtypes: none Specify: with marked stressors (brief reactive psychosis) without marked stressors with postpartum onset during pregnancy 4 weeks postpartum

Question 60

Schizophrenia Spectrum & Other Psychotic | Brief Psychotic Disorder

Answer 60

``` Associated Features: emotional upheaval rapid, intense affect shifts increase suicide risk (acute episode) severe level of impairment supervision required poor judgment cognitive impairments delusions ``` Onset: average age mid 30s Predisposition: schizotypal/borderline personality disorders

Question 61

Schizophrenia Spectrum & Other Psychotic | Schizophreniform Disorder

Answer 61

Diagnostic Criteria: pages 96-97 ``` Specify: with good prognostic features two of the following are present *good premorbid functioning *onset of psychotic symptoms within 4 weeks *confusion/perplexity *no blunted/flat affect without good prognostic features ``` with catatonia

Question 62

Schizophrenia Spectrum & Other Psychotic | Schizophreniform Disorder

Answer 62

Severity Specifiers quantitative assessment of primary symptoms of psychosis ``` Diagnostic Features Schizophreniform Disorder is distinguished from Schizophrenia duration of symptoms at least 1 month less than 6 months ``` does not have functional impairment requirement 2/3 diagnosed > schizophrenia or schizoaffective

Question 63

Schizophrenia Spectrum & Other Psychotic Schizophrenia

Answer 63

``` Associated Features: inappropriate affect dysphoric mood disinterest in eating depersonalization (disengaged) derealization (surroundings not real) somatic anxiety/phobias sensory processing cognitive deficits ```

Question 64

Schizophrenia Spectrum & Other Psychotic Schizophrenia

Answer 64

``` Associated Features (cont.) anosognosia: unaware of illness {treatment noncompliance} ``` **aggression: more frequent in males past history of violence, substance, impulsivity ``` Course Development: late teens – mid 30s first psychotic episode males: early 20s females: late 20s ```

Question 65

Schizophrenia Spectrum & Other Psychotic Schizophrenia

Answer 65

Course Development cont. onset typically insidious earlier onset > poorer prognosis Higher risk of suicide command response Significant social/occupational impairment High comorbidity with substance-related disorders Reduction in life expectancy

Question 66

Schizoaffective Disorder

Answer 66

Diagnostic Criteria: pg. 105 positive symptoms AND concurrent major mood episode Specify: 295.70 (F25.0) Bipolar Type manic episode 295.70 (F25.1) Depressive Type with catatonia Course Specifiers: after one year (pg.106)

Question 67

Schizoaffective Disorder

Answer 67

Associated Features: frequent occupational functioning impairment less severe negative symptoms anosognosia: common (poor insight) increased risk for MDD or BD substance related disorders & anxiety disorders common Onset: early adulthood

Question 68

Substance/Medication Induced Psychotic Disorder

Answer 68

Diagnostic Criteria: page 110 Need one or both: hallucinations delusions Specify: with onset during intoxication with onset during withdrawal Severity Specifiers: page111 assess primary symptoms of psychosis each rated for severity within past 7 days

Question 69

Substance/Medication Induced

Answer 69

``` Substances associated with intoxication: alcohol cannabis hallucinogens (includes PCP) stimulants (includes cocaine) anxiolytics inhalants sedatives ``` With withdrawal: alcohol hypnotics anxiolytics “other” sedatives